American Association of Plastic Surgeons

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Reconstructing Soft Tissue Sarcoma Patients: Tumor Bed Excision Defects Are Deceiving and Result in Higher Reoperation Rates
Rami Elmorsi, MD, Luis Camacho, MD, David D Krijgh, MD, Gordon S Tilney, PA-C, Heather Lyu, MD, MBI, Raymond S Traweek, MD, Russel G Witt, MD, MAS, MS, Margaret S Roubaud, MD, Arlene Correa, PhD, Christina L Roland, MD, MD, Alexander F Mericli, MD
MD Anderson Cancer Centre, Houston, TX, USA

PURPOSE: Soft Tissue Sarcomas (STS) may be misdiagnosed and/or inadequately resected, leaving behind microscopic disease that necessitates a secondary Tumor Bed Excision (TBE). Little is known about these patientsí course and outcomes given the rarity of centers treating them.
METHODS: We retrospectively analyzed reconstructed cases from 2016 to 2021, comparing TBE to mass excisions (ME). Demographics, oncological variables, reconstructive techniques, and outcomes were included. Parametric and non-parametric comparisons were employed as appropriate.
RESULTS: In contrast to STS ME, TBE patients were mostly females, had shorter hospital stays, longer follow-up periods, and more plastic surgery involvement (p<0.05). The two groups differed significantly in sarcoma locations, pathologies, and defect dimensions, with TBE being smaller than ME (p<0.05). TBE had significantly greater rates of reoperation (16% vs. 8.5%; p=0.03) and graft loss (38.9% vs. 15.6%; p<0.001), but overall complications were similar between the groups (39.6% vs. 31.3%; p=0.13). Tables 1 and 2 are univariate analyses for complications in both groups.
CONCLUSION: Although TBE defects are significantly smaller, they have a greater reoperation rate. While both TBE and ME defects stem from STS excisions, they seem to differ clinically from a wound-healing perspective. Plastic Surgeons should consider advanced reconstructive options, especially for TBE defects.

Univariate Analysis for Overall Complications in Tumor Bed Excision Defects Reconstruction (n=106).
OR (95% CI)p
Male2.3 (1.05-5.1)0.03
Medial Thigh5.7 (1.7-19.2)0.002
Local Flap3.5 (1.1-11.2)0.03
Full Thickness Skin Graft3.5 (1.1-11.2)0.03
Pedicled Flap0.3 (0.12-0.89)0.02
Free Flap0.2 (0.06-0.89)0.02
Neoadjuvant Chemotherapy0.08 (0.01-0.66)0.004

Univariate Analysis for Overall Complications in Mass Excision Defects Reconstruction
95% CIp
Tumor Thickness1.07 (1-1.11)0.005
Medial Thigh2.6 (1.4-4.7)0.002
Complex Repair2.8 (1.6-4.9)0.001
Free Flap0.38 (0.15-0.96)0.03
Hypertension1.8 (1.1-3.1)0.02
Preoperative Radiotherapy2.7 (1.3-5.7)0.005

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